At the close of 2020, the U.S. Congress passed the No Surprises Act to end the pernicious practice of so-called surprise billing for out-of-network care. But the country’s recent experience with balance-billing prohibitions for Covid-19 testing and treatment offers an ominous warning. The Coronavirus Aid, Relief, and Economic Security (CARES) Act barred providers from collecting copayments and pursuing balance bills for coronavirus testing and treatment in exchange for receiving bailout funds. Reports have documented a nationwide persistence of surprise bills for Covid-related care, however. The continued existence of ostensibly illegal bills has been attributed to multiple causes — including omitted Covid-19 diagnoses, upcoding, human error, billing-related confusion, simple noncompliance with federal rules, and various loopholes2 — but the lesson is clear: in the health care sector, making certain practices illegal isn’t enough to prevent them from occurring.
